Aortic Stenosis Best Treated With Transcatheter Aortic Valve Replacement (TAVR) in the Elderly

Aortic stenosis is a common form of heart disease, in which the aortic valve does not open fully and decreases blood flow from the heart. Treatment options include open heart surgery, minimally invasive transcatheter aortic valve replacement (TAVR), or balloon aortic valvuloplasty (inserting a catheter into the groin and inflating a small balloon in the aortic valve to open it). A new study has found that TAVR to replace the aortic valve without doing open heart surgery, for people who are elderly or too frail for open heart surgery, has better outcomes after five years than patients who did not have surgery at all. TAVR may allow patients a better quality of life than the standard therapy of balloon aortic valvuloplasty. Researchers followed 358 patients with severe aortic stenosis for five years. The patients' average age was 83-years, and they were evenly divided into two groups- one that had TAVR to replace their valve and one that had balloon aortic valvuloplasty but no surgery. It was found that after five years, 28% of the TAVR group were still alive, compared to only 6.4% of the standard therapy group. The study also found that those who had TAVR lived longer, with better symptom management, fewer hospital re-admissions and better functional status.

Study author Samir Kapadia, director of the Sones Cardiac Catheterization Laboratories at Cleveland Clinic, said, "This trial is the first, and will probably be the only, randomized aortic stenosis trial that includes a group of patients not treated with aortic valve replacement, since these results will make it unethical to treat severe aortic stenosis patients with medical therapy alone."

The study was published in The Lancet, and presented at the American College of Cardiology (ACC) annual conference in San Diego, California.

Another study released at the ACC conference showed promise for a new device, called TriGuard, that helps surgeons prevent dangerous debris from reaching the brain during TAVR, resulting in better cognitive scores for patients who underwent the procedure. The new device covers the three arteries that lead to the brain with a temporary mesh shield. A small trial involving 83 patients showed 22.2% of patients with the device had heart or brain complications in the week after surgery, compared to 31.6% without the protective mesh. Fewer patients died after the procedure in the group using the mesh, 2.2% compared to 5.3% in the control group.

Source-Medindia